Fla. Admin. Code Ann. R. 59A-12.003 - Administration, Forms, Fees
(1)
Application. "Application for Health Care Provider Certificate", AHCA Form
3002, Feb. 1998, obtained from the Agency for Health Care Administration, 2727
Mahan Drive, Mail Stop 26, Tallahassee, Florida 32308, which forms are
incorporated herein by reference, must be completed in the manner specified
within the application in order for each individual item to be considered
complete for the purpose of determining that a properly completed application
has been filed. The application shall be accompanied by a filing fee of
$1,000.00 payable to AHCA and shall be completed by each entity desiring to
obtain a Health Care Provider Certificate as an HMO or PHC. The application
shall specify the contact person or persons for the HMO or PHC. During the
review of the entity only contact persons specified within the application
shall be allowed access to the application materials submitted.
(2) Application Review Process for Health
Care Provider Certificate. Upon receipt of the Application for Health Care
Provider Certificate from a proposed HMO or PHC, AHCA shall review the
application within 30 days of receipt. AHCA shall provide notification to the
proposed HMO or PHC of deficiencies in the application within this 30-day
period. The applicant has 90 days from the date of the filing of the
application to file any additional information requested by AHCA. By the end of
the 90-day period if the additional information has not been received the
application will be denied in accordance with Chapter 120, F.S. Within 90 days
after the application has been completed AHCA shall approve or deny the
application.
(3) Certificate of
Authority. The application for a Health Care Provider Certificate must include
a copy of the letter from the Department of Financial Services accepting the
receipt of an application for a Certificate of Authority submitted by the
organization.
(4) Geographic Area
Expansions. The HMO or PHC may not change its geographic area unless it follows
the applicable requirements set forth in Section 641.495(2), F.S. Each HMO or
PHC shall submit the required notarized "Affidavit by HMO for Expansion of
Service Area", AHCA Form 3160-1005, April 2002, which is hereby adopted and
incorporated by reference. Copies may be obtained by writing AHCA, 2727 Mahan
Drive, Mail Stop 26, Tallahassee, Florida 32308.
(5) Annual Assessment. The Agency for Health
Care Administration shall determine the regulatory assessment percentage
necessary to be imposed for each calendar year. AHCA Form "Regulatory
Assessment Worksheet for Health Maintenance Organizations, Prepaid Health
Clinics, and Exclusive Provider Organizations", AHCA Form 3160-1004, July 1995,
which is hereby adopted and incorporated by reference, will be provided to the
organization for calculating the annual regulatory assessment percentage and
premium volume. Copies may be obtained by writing the Agency for Health Care
Administration, 2727 Mahan Drive, Mail Stop 26, Tallahassee, Florida 32308. The
annual regulatory assessment shall not exceed the statutory limitations and
must be paid by the date specified in the Administrative Assessment
Order.
Notes
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